Reciipiientt Outtcomes iin Adulltt Liiviing Liiver Transpllanttattiion

Abstract

Liver transplantation is perceived as the only curative treatment for patients with end-stage liver disease. Approximately 20–25% of patients with liver failure die while waiting for a liver transplant, and another 20–30% of patients with hepatocellular carcinoma drop off the waiting list because of tumour progression. LDLT has emerged as the alternative life-saving treatment to DDLT. Over the past 2 decades, the number of LDLTs has steadily increased in many transplant centres, especially in Asia. LDLT has the following advantages over DDLT: a shorter wait time, a shorter cold ischemic time, and a better organization of the surgery time. However, donor risks are inevitable and are an undeniable problem that troubles transplant surgeons. Moreover, LDLT has a smaller biliary and vascular caliber and an additional transection step, which may potentially increase the surgical risk and the incidence of postoperative complications. Previous investigations have suggested that patients undergoing LDLT may have a higher incidence of biliary and vascular complications and a lower long-term survival rate than patients undergoing DDLT. As surgical techniques and postoperative managements continue to advance, the outcomes of LDLT have continued to improve. Patients considering LDLT should know whether the risk, severity of complications and long-term survival. Postoperative biliary complication is commonly referred to as the “Achilles heel” of liver transplantation. Despite progress in surgical techniques, organ preservation and immunosuppressive management, biliary complications still frequently occur after liver transplantation (7–29%) and have retained a high risk of significant mortality and morbidity. Anastomotic problems have been the major reason for biliary complications, despite various innovations for biliary reconstruction that have been achieved for whole organ liver transplantation. Vascular complications are another common cause of morbidity of liver transplantation, especially hepatic artery problems. The literature reports the hepatic artery complication rate to be approximately 5%–16%. Due to the smaller vessel diameter, the insufficient length for reconstruction and the greater risk of a twist of the vascular pedicle, LDLT patients may suffer from a higher incidence of vascular complications. The hepatic artery complication rate is much lower as Reconstruction of the hepatic artery using microsurgical techniques with the help of a trained vascular surgeon. During the hepatic artery reconstruction, Selecting an appropriate anastomotic artery for hepatic artery reconstruction is very important. This approach greatly reduced the hepatic artery complication rate in the recepient. Furthermore, intraoperative Doppler ultrasound was used in LDLT. The use of intraoperative Doppler ultrasound can reduce vascular complications following the liver transplantation.